Surgical instrument



SelPt- 27, '1932- B. D. LAFoRcE 1,879,339

SURGICAL INSTRUMENT Filed July '7, 1931 fr0/PMSA?.

Patented Sept. 27, 1932 Bunnnrrnn. LA. ronca, or ALTADNLcALrFORNIA Y sumaron. INSTRUMENT lApplication ledrJ'uly, 1931. Serial No( 549,209.

My invention relates to the type of surgical instruments called tonsillotomes, tonsil enucleators, and tonsil snares. The lprimary purpose of my instrumentis for the removal of faucial tonsil. Y

Myy invention has a number of different features, all of which may .beutilizedin their proper sequence or succession or, if desired, certain of the instruments and certain l of the steps of procedure may be omitted. lith my instrument I provide for What I term fixing the tonsil and utilize `what I term a fixing blade. This procedure is to lift a deeply embedded and submerged tonsil from its bed and this may be effectivelydone by myinstrument which has a very thm blade,

e this'being adapted to underminea tonsil and lix it in the forward end ofthe instrument,

this securing the cap ofthe tonsil with all c-n of its capsule intact. `llith my type of inR strument little danger of leaving any of the tonsil in the sinus tonsillaris. This fixing bladeyas above mentioned, is quite thin and is designed to operate in the fenestra ofia tonsillotome. Such blade is not Vsharp enough .to sever the tissues but acts to push such'tissues attachedto or forming part of the tonsil to the fori Ward end of the frame of the instrument and 3o fix them there. Y,

Another object and feature of my invention is the employment with the fixing blade of a hemostat blade, this being designed Vwhen thrust forward in the fenestra of the instrument to thoroughly crush the tissues. This blade is thiclrenough to accomplish-the `desired hemostasis. In 'my present instrument the forward end of this thick .hemosta-t blade is preferably beveled.,

Another object and feature ofimy invention is the provision ofa cutting blade or a snare, either typeo'f severing the tonsil being l adaptable for my instrument, such. blade,

manifestly, having a sharp edge vand the;

snare, if used, having a means for; retracting same `whereby the tonsilmay be severed.v Another object and feature "of myinvention is Vthe employment of what'may'be termed a clamping blade,` this blade being n broughtto bear on the tonsil ve-itherbefore having this fixing blade there is v or immediatelyiafter the 'severing operation, l i

such blade being forcedfto thel end.. of the fenestra and thereby clamping the tonsil' so that it can be readily removed vfrom apersons throat onv removal of theinstrument. y

Another object and-feature of my nvn-f'.

tion is the employment of a safety device action until the tonsil has been first gripped by the fixing blade. I providethis safety is danger that thesurgeon may have his attention divertedifrom the instrument and Ilot enabling a safe vmethod of operation and pro-f i viding a device whichvwill notfallow the cut-i ting or severing blade to be brought into o noticefthe position-,of the severingblade.

Therefore,-I provide-a positive lockngpdevicewhich will prevent operation of thevs'evering blade until the fixing bladel has been properly actuated to disengagethe embedded l tonsil and to properly grip such tonsil. This safety locking device employsra vertical bolt or rod which passes through slots in both the fixing andthe severing ,blade and has means for interengaging with these blades'to pre# lvent operation of the severing bladeuntil 'the fixing blade has been brought intoits-proper action and performed vits function Another object .and a.` mechanical `feature of my invention leading toward its simplicity of construction and operation is a combiningV of. the hemostat blade with certain ofthe other blades of the instrument, for instance; the hemostatzbladermay be combined and made integralv with thel fixing blade so that asthe fixing bladeris `used to loosen andkrdis-V engage the embedded tissues andafter these l gf are properly secured the hemostat blade Will function to crush thetissues held adj acent the fixing blade. V- Another modication f'conibined'blades is the'combining off-'the hemo- 47stat blade With the severing blade'in that these'may be madeintegral, orthesevering blade maybe constructed With the-hemostat block formed thereon, in which case 'as-the tonsil is severed the hemostat blade is brought into action to crush the tissues; g Thecombin-l ing of blades enables the instrument to be simplified and the technique or manner of operation to be also simplified. Another object and feature of my invenvtiem-especially when a snare is used instead of cutting blade, is that both the fixing and@` the hemostat blade secure the tonsil lat one portion and the clamping blade-vat another portion. Therefore, the snare, which operates between these sets of. blades effectively severs the tonsil which is firmly held from r with. v

Another object and feature of my invention is to provide the closure end ofthe fenestra of the instrument with'a thin, upright projecting edge which extends above the sides ofthe fenestra, and such being adapted to" act las ajpry'when pressed between the faucial tonsil and the posterior pillar of the tonsil to dislodge the tonsil from its bed and help to introduce the tonsil into and through the' fenestra of the instrument.

My invention is illustrated in connection with the accompanying drawing, in which Fig. 1 is a side elevation of my invention partly'broken away; Y

2 is an enlarged longitudinal section through the fenestra end taken on'the line 2-2`ofFig.3; y Fig. 3 is a transverse section on the line 3 3 of Fig. 2 in the direction-of the arrows; Figl.-4 is a detailed longitudinal section of part of the instrument taken substantially on the line 4t-f4 of Fig. 5 in the direction of the arrows; i A t Fig; 5 is a detailed plan taken'on the line 5-5 of Figy4 in the direction of thearrows; Fig. 6 vis a Aside elevation partlyk broken awa-y of aportionof the instrument, showing an alternative f0rm,rusing a snare; Y f Fig. 7 is a detailed perspective view'of combination hemostat and knife blade;

Fig. 8 lis a perspective view of acombination fixing and hemostat blade; i v

Fig. 9 is a side elevation of the blade of Fig. 8 takenin the direction of the arrow9.- In instrument I provide a main frame 11 which has a horizontal bar section12, a vertical bar 13 at one end, vfrom whichend dependsa hand pistol grip type of handle t 14. A sloping bar section 15'eXtends upward- 1y from vthe'end of the horizontal portion 12 andv has ya. horizontal bedrbar 16 extending therefrom. `This terminatesin the fenestra end 17of the frame. Such fenestra end has twoV side structures A18, an end closure 19,.the sides terminating at 20, thev portion 16Qter-j minating at 21, leaving a large fenestrapopen-i vertical sectionI 26. A slot 27 to accommodateV theknifeblade extends into or vthrough the l,closure end 19: and below this there is another vertical surface 28. The inside of 4Hthevfrifni23 preferably has vertical corrugations andthe inside of the lower beveled portion 25 :hasvertical corrugations. At the sides there is an upper rim 29 (note Fig. 3)

below which there is 'a wide ribv 30 and a, lowe'r'rimflr, this forming an upper Yguide vslot 32,lower'1guide slots 33.

The lower bnr 12 is providedV with an elongatedslot 34,'this having a wide sectionk 35 atone end,'thef slot extending from the line 361:0 the line 371i.' Ontheupper edge ofthis bar 0n each side of this slot there is a toothed friction surface 38 for the purpose hereinunder detailed'.- The if'erticalibar 13 is provided with aperforation 39 and at the top Athere is a-.vertical notch 40.

In the drawings, the fixing blade designated as 41=Ihas athin operating end42 which hasits marginal edges sliding in the upper groove 32. This: blade has a vertical pressure edge 43 which presses against the of the rim23. Thefportion 44 loffthis blade isthickened and another portion 45 is still thicker and has .a threaded stem 46 formed integral therewith, this vthreaded end lit-ting in they notch 40-and having a: thumb engaging end-47 :toallowl pressing forward of this blade. The portion45 of the blade has a perforation 48 for a purpose hereinunder detailed. A finger operated nut 49 is threaded on thev threaded stem4 and is adapted for clamping this fixing blade in itsfoperative position after vbeing thrust forward to press The hmostat bladedesignated, as 5() is yinside surface p quite. thick. and is positioned below the fiX- Y ing'blade. This hasla thinner end portion 51 randits forward"edge"52 is formed with bevelslto fit against thebeveled surfaces 24 and 251. This vend of the hemostat blade has vertical corrugations. zv Such blade has a thin section 53, a down-wardljlv extending portion t 54, and a vertical end 55, which has a notch 56 therein. This.v notch allows fitting in a groove'? in a second finger operated nutl 58 on the stem 46.V Therefore, by operating this screw the hemostat blade'may be forced forwardly' in'the fenestra to press the tissues of the tonsil against the :abutments 24 and 25. VThe'hemostat bladeis'provided with an elongatedslot 59. Thisslothas an enlarged end v6.0 fora purpose hereinunder detailed.

f .The cutting orseveringkn'ifel hasa Cutthe hemostat blade by providing the blade with a perforation 64 in which fits the pin 65 extending downwardly from the hemostat blade so that on the rearward movement of the hemostat blade the knife blade is moved rearward. It will be noted that as the knife edge extends forwardly ofthe i heinostat edge 52 that the knife cuts the tonimmediately after severing.

sil before the hemostat action is brought into play but the heinostat blade crushes the tonsil The clamping blade 66 is the bottommost blade of the set. This blade. is formed quite thin on al straight portion 67 which slides in the vside guide. grooves 33. Such blade has a vertical end edge 68 which bears against the vertical surface 28 of the end closure 19 of the fenestra. This blade is provided with a downwardly curved portion 69, this having a slot 70 therein.A Suchblade is attached to a` block 71 which has a tooth 72 at its lower forward edge. A stem 73 is connected.

to the block, which stem extends through the perforation 39 immediately above the handle 14. The end of the stem has a knob 74 to allow pressure by the thumb for thrusting this clamping blade forwardly to clamp the tonsil. The tooth 72 engages in the teeth or serrations 38 and preventsretraction of such blade.

A safety device which provides a positive lock for the cutting blade and prevents the use of Vthis until the fixing blade has engaged the tonsil is by the provision of the pin 76 (note Figs. 4 and 5'). This pin has a knob 77 at the bottom, an enlarged collar 78, a contracted stem portion 79, a larger cylindrical upper portion 80, and is threaded at the top 81, on which end a nurled nut 82 is threaded. This pin when in its lowered position ts in the slot 34 of the bar 12, the collar 7 8 preventing its Vforward'movement. It extends through the slot 70 in the clamping blade 66 and extends'through the slot 59 and the enlarged portion 60 of the heniostat blade. The enlarged section 8() is of sufficient diameter that it will not permit sliding of'the knife blade in a forward direction on account of the section being too great a diameter to operate in the slot 59. The pin is thrust forwardly with the fixing blade being yengaged at the upper portion in the perforation 48 when this fixing blade is thrust YinV by the thumb engaging end 47. However, the adjustment Vof the hemostat blade and the knife by means of the thumb.

nut 58 is such that the-end of the fixing blade must engage the rim 23 but the enlarged part 35 of the slot 3 4 in the bar 12 allows the pin 76 to be thrust upwardly by pressure on `the headA 77. VWhe'n'ii'n this position the collar 78 may be thrust in with the enlarged portion 35 of the slot 34 and thisraises the enlarged cylindrical portion 80 above the slot 59 and allows the hemostat blade with the knife to be thrust forwardly toward the closure end of the fenestra by means of thev finger nut 58. It will, therefore, be seen that I have provided a safety factor in that the knife cannot be brought into operation until after the tonsil has been engaged by the fixing blade, and whenthis hemostat blade and the knife are forced forwardly the knob 74 is pressed, thus thrusting the clamping blade forward to engage the closure end 19 of the fe-nestra. Thus the tonsil is gripped by this clamping blade and may beiheld while the knife, the hemostat blade, and the fixing blade are retracted.

As above mentioned, to simplify the device, certain of these blades maybe combined, and in Fig. 7 I show a combined hemostat and cutting blade designated by the assembly number 83. This has a blade'shank 84, a cutting blade in alignment with Vthis sha-nk and having a cutting edge 86.

The sides of this blade operate in the lower groove 33. Secured to one side of this blade v ing and hemostat blade designated by the as- Y Y sembly number 89. In this case there is a heavy blade shank having the fixing blade edge 91 on the top. This blade projects beyond the hemostat face 92-of the hemostat portion 93 of the blade. A pair of side fins 94 are provided, these side'fins being guided in the upper guide groove 32 and the hemostat blade fitting between the ribs 30. The face 92 of the hemostat blade is shaped to conform to the end of the instrument so that as the fixing blade is brought into operation to engage and fix the tonsil the hemostat vblade is also used to crush the tissues.

In Fig. 6 I show a modified construction in which a snare 95 is utilized. This snare has side wires 96 and an end wire 97. Such end wire when in the operative position is accommodated in the slot 27. When using the snare I prefer to have the combined'hemostat and fixing blade 89, this being illustrated in Fig; 6, and also the clamping blade 66 so lthat the tonsil may be gripped between the fixing blade and the clamp and crushed by the hemostat blade before a tension is placed on the wires 96, which may be done' in any suitable manner so that the end wire 97 is pulled through the tonsil. In this construction the snare is connected to a thumb nut on V the stem 46 to exert a pull instead of a thrust.

76 engaging the end of the slot 70 in the curve portion 69 of the clamping blade 66.

The technique in handling my instrument is substantially as follows: n j

The forward end of the instrument is pressed deeply into the tissues between the tonsil and the posterior pillan The instrument is manipulated to force the end of the instrument against the tissues attached to the tonsil. The retraction of the end of the instrument acts to pry the tonsil out of its bed and to bulge the tonsil outward. The specially provided and devised fixing blade is now pressed forwardk between the bulging tonsil and the anterior pillar to further dislodge, lift and shell the tonsil out, into and through the fenestra of the instrument. As the blade (roes forward the tissues attached to the tonsil are fixed in the forward end of the instrument. The tissues so fixed are now locked in the fixing device by turning the posterior wheel attached to the fixingblade to the left to force it very tightly against the frame of the instrument.

Having the tissues attached to the tonsil firmly fixed in the end of the instrument, a

` second blade herein described as a clamping blade-is pressed forward to clamp a portion of the tonsil or the tissues to which it is attached to support the tissues and to obviate the necessity of grasping the tonsil with forceps after it has been severed to remove it from the throat. The ratchet device lautomatically locks the clamping blade.

The tissues now lying between the clamp .ing devices are thoroughly crushed to prevent hemorrhage and are to be severed. This part of the operation is accomplished by the instrument as herein shown in a completely assembled instrument by turning the wheel attached to the hemostat blade to the righ-t. Asthe knife blade is connected to the hemostat blade its cutting edge goes forward to sever the tonsil from its attachments but as the blade goes farther forward the hemostat comes into play to crush the tissues. VAfter the knife has severed the tissues the ends of the blood vessels slightly retract and the hemostat acts to crush the ends of the blood vessels to close the lumen of the vessels to prevent bleeding. Before the hemostat blade with the knife blade attached to it can be forced forward to sever and to crush the tissues the safety device if it does not readily drop in place to permit the blade to be forced forward may be slightly pressed upon to free the action of the hemostat blade. y

After the tonsil has been severed and the tissues which have been attached to it thoroughly crushed, the hemostat and knife blade should be retracted toits former position by turning the wheel attached to it to the left. This manipulation will release the safety device so that it will fall in place or may be slightly pressed upon to permit the fixing blade to be retracted from its locked position and the instrument removed from the throat.

ltwill be seen from the above description of the instrument together with the drawing that have provided a new and important device in what I may call the fixing portion of the instrument, this portion being composed of a specially devised end of the instrument to assist in lifting the tonsil from its bed, and in the specially provided and constructed xing blade, the forward end of which fixing blade is designed to cooperate withthe up-turned part of the end of the frame at the end'of the fenestra. These instrumentalities, together with the arrangement for crushing and severing, provide an improved manner in which the faucial tonsil maybe dislodged from its bed inthe sinus tonsillaris, crushed and severed in a bloodless operation. It is believed that with my improved instrument and in the manner inl which it is used that a radical advance has been made in the surgery of the removal of the faucial tonsil. f

The closure end 19 of the fenestra of the instrument above the thin rim 23 is provided with a slight upward projection at 23 which extends slightly -above the upper plane of the instrument and above the upper side rims 29. This is adapted to act as a pry when pressed between the faucial tonsil and the posterior pillar of the throat to dislodge the tonsil from its bed and help to introduce the tonsil into and through the fenestra of the instrument.

Various changes may be made in the details of construction without departing from the spirit or scope of the invention as defined by the appended claims.

I claim:

l. A surgical instrument having a frame with a fenestra, a slidably mounted fixing blade adapted to engage and free a tonsil, a slidably mounted hemos'tat blade to crush the tissues, and a slidably mounted means to sever the tonsil.

2. A surgical instrument having a frame with a fenestra, a slidably mounted fixing blade to engage and free a tonsil, a slidably mounted hemostat blade to crush the tissues, a slidably mounted clamping blade to engage the tonsil, and a slidably mounted severing means to sever the tonsil.

3. A surgical instrument as claimed in claim 2, a locking means interconnecting the fixing blade and the severing means to pre- .vent operation of the severing means before l claim 9, a' yclamping blade slidably mounted 4. A surgical instrument having a fenessevering .blade opposite to that vof the fixing blade and being adaptedto clampthetonsilv operation of the fixing blade.

tra, a slidably mounted fixing blade to engage and free a tonsil, a slidably mounted severing means, and a positive locking device interconnecting the fixing blade and the severing means to prevent operation of the severing means until the fixing blade has engaged the tonsil.

5. A surgical instrument having a fenestra, a slidably mounted fixing blade to engage a tonsil, a slidably mounted hemostat blade to crush the tissues, a slidably'mounted severing means, a locking device interconnecting the fixing blade and the severing means to prevent operation of the severing means until the tonsil is engaged and gripped by the fixing blade.

6. A surgical instrument as claimed in claim 5, having in addition a slidably Vmounted clamping 'blade to clamp the tonsil.

7. A surgical instrumentvhaving a frame with a fenestra, a slidably-y mounted fixing blade to engage a Vtonsil, a slidably mounted hemostat blade, a severing blade,fand means interconnecting the hemostat blade and `the severing blade to cause said blades to act together. I

S. A surgical instrument as claimed in claim 7, a locking means interconnecting the Vfixing blade, the hemostat and the severing blade to prevent operation of the hemostat and severing blade until the `tonsil has been engaged and gripped by the fixing blade.

9. A surgical instrument having a frame and a fenestra, a slidably mounted fixing blade to engage and retain a tonsil, a slidably mounted hemostat blade, a slidably mounted severing blade, the hemostat blade and the severing blade being rigidly attached together.

10. A surgical instrument having a frame and a fenestra, a slidably mounted fixing blade to engage and retain a tonsil, a slidably mounted hemostat blade, a slidable severing means, the fixing blade and the hemostat blade being rigidly connected together.

11. A surgical instrument having a frame With a fenestra, a slidably mounted hemostat blade, a slidably mounted clamping blade, and a slidably mounted severing means positicned intermediate'between the hemostat and the clamping blade. c

12. A surgical instrument having a frame and a fenestra, a slidably mounted fixing blade to engage and retain a tonsil, a slidably mounted hemostat blade, a slidably mounted severing blade, the hemostat blade and the severing blade being rigidly attached together, and a locking means interconnecting the fixing blade and the combined hemostat and severing blade to prevent operationy of such latter blade until the tonsil has been engaged and gripped by the fixing blade.

n 113.] A .surgical instrument as claimed onthe side Vofthe combined hemostat and 14. Ansurgi'calV instrument having afiame Landa fen-estre, a slidably mounted fixing blade to engage and retain .a.t on`sil, a .slid` ablyxmounted hemostat blade, a slidably mounted severing blade, the hemostat blade and .the severing blade lbeingrigidly attachedV Vtogether, a locking means interconnecting thefixing .blade and the combined hemostat and severing blade prevent operation .of

.such latter-blade Yruntil the tonsil has been engaged 'and gripped by the fixingblade, a kclamping blade slidably mounted on the side of the combined-hemostat and severing 'blade oppositeto that vr*of the fixing'bla'de and being adapted torclamp the tonsil.y

15,y A surgical instrument having a frame and afenestra, a slidably mounted fixing blade to engage .and retain a tonsil,:aslid-l ably v4.mounted hemostat' blade, Y. a slidably mounted severing means, the xing blade and .the .hemostat blade being rigidly connected together, .and a locking device interconnect- K ing the combinedfixing bladeand hemostat blade :and the severing meangsto prevent operation of the severing means until the fixing blade has engaged the tonsil.

16. A surgical y instrument as claimed` in claimlf), having in addition a clamping blade on the opposite side of the severing means to that of the combined fixing and hemostat blades and slidably mounted in the frame to have its operative end slide in said fenestra.

17. A surgical instrument having a frame and a fenestra, a slidably mounted fixing blade to engage and retain a tonsil, a slidably mounted hemostat blade, a slidably mounted severing means, the fixing blade and the hemostat blade being rigidly connected together, and a locking device interconnecting the combined fixing blade and hemostat blade and the severing means to prevent operation of the severing means until the fixing blade has engaged qthe tonsil, andhaving in addi-V tion a clamping blade on the opposite side of the severing means to that of the combined fixing `and hemostat "blades and slidably mounted in the frame to have its operative end slide in said fenestra.

18..,A surgical instrument having a frame with a fenestra, a slidably mounted fixing blade, a slidably mounted severing means, the fixing blade having a perforation therethrough, the severing means having an elongated slot and the frame having an elonated slot, each with enlargements at one end, Y

the pin having an enlarged collar fitting in means, said pin also -having an enlarged said perforation and adapted to extend into the enlargement of the lslot in the severing Y,

Y `ward movement of said pin except when Vin alignment Withthe enlargement of the slot in the frame, said pin having a section of reduced diameter to slide in the lcontracted p0rtion of the slots in the severing means and in the frame.

1 19. A surgical instrument having a frame With a fenestr'a, said frame having a lower bar with an elongated slottherethrougli, said slot having an enlargement at one end, a

slidably mounted fixing blade having a perforation, a slidably mounted severing blade having an elongated slot with an enlargement at one end, a hemostat blade interlconnected with thesevering blade, a elamping bladehaving an elongated slot, a locking vrpin having a relatively small stem portion and enlarged collar adjacent the bottom, and

a second enlargedk section at the top itting in said perforation, the contracted portion being adapted to slide Vin the slots in 'the severing blade and in the bar of the frame, and the enlarged portion and the collar being adapted to allow" upward movement of Y the pin inthe enlarged portions ofV the `slots Vof the iixing blade and theibarof the frame.

Intestimony whereof I have name to this'speeifoation. 'l

BURDETTE VD. LA FORCE.

signed my la Y 

